Cost-Effectiveness of Umeclidinium/Vilanterol versus Salmeterol/Fluticasone in Elderly Patients with Chronic Obstructive Pulmonary Diseases in China

Figures & data

Figure 1 State transition diagram of Markov model.

Table 1 Annual Transition Probabilities for Markov Model

Parameter	Value			Reference
Patients by initial health states (%)	S2:83.20%	S3:14.80%	S4:2.00%	[^Citation12]
Transition probabilities
UMEC/VIL	S2→S3:3.10%	S3→S4:3.00%		[^Citation9]
FSC	S2→S3:2.93%	S3→S4:9.56%		[^Citation14]
Risk of exacerbation with FSC (%)	Non-severe exacerbation:41.86% Severe exacerbation:20.93%			[^Citation15]
Rate ratio of exacerbation (versus placebo)	Placebo:1	FSC: 0.75	UMEC/VIL:0.65	[^Citation16,Citation17]

Table 2 COPD-Related Mortality Risk by Age and Severity Stage

	Patient Subgroup	Mortality in TIOSPIR (%/y)
60≤ Age<70	GOLDI~II	1.37
	GOLD III	2.13
	GOLD IV	4.56
Age ≥ 70	GOLDI~II	3.06
	GOLD III	4.00
	GOLD IV	8.43

Table 3 Resource Use and Annual Costs (USD 2021) for Markov Model

Direct Medical Costs
Drug costs	Dosage		Cost ($)		Reference
UMEC/VIL  (62.5/25 µg)	62.5/25µg qd		415.93		Calculated from Official data^a
FSC (50/500µg)	50/500µg bid		569.28		Calculated from Official data^a
Other maintenance costs	Resource use	Unit cost ($)		Cost ($)	Reference
Outpatient visit	4	2.19		8.75	Calculated from Official data^b
Pulmonary function test	1	34.34		34.34	Calculated from Official data^b
Influenza vaccine	1	6.40		6.40	Calculated from Official data^a
23-valent pneumococcal vaccine	0.2	29.66		5.93	Calculated from Official data^a
Theophylline, expectorant, oral hormones, oxygen therapy	–	–		S2:37.94 S3:51.55 S4:73.32	[^Citation22]
Costs of exacerbations	S2	S3		S4	Reference
Severe exacerbation	982.74	1257.76		1679.66	Calculated from^Citation23
Nonsevere exacerbation	71.56	74.65		114.06	Calculated from^Citation23
Direct Non-Medical Costs
	S2	S3		S4	Reference
Transportation, health care and nutrition	115.60	116.04		116.92	Calculated from^Citation23
Indirect Medical Costs
	S2	S3		S4	Reference
Productivity loss	581.10	516.58		223.28	Calculated from^Citation23

Notes: ^ahttps://www.scyxzbcg.cn/std/login.html. ^bHospital medical service price.

Table 4 Cost-Effectiveness Analysis of Two Regimens

	UMEC/VIL	FSC
Total Costs (C, $)	9433.84	11,381.02
Costs for exacerbation ($)	1248.05	2245.21
QALY	5.17	5.12
Life year (LY)	9.47	9.36
ΔC/ΔQALY	UMEC/VI dominates
ΔC/ΔLY	UMEC/VI dominates

Figure 2 Cohort analysis model of UMEC/VIL group.

Figure 3 Cohort analysis model of FSC group.

Figure 4 Tornado diagram (ICER, UMEC/VIL vs FSC).

Figure 5 Scatter plot of incremental cost-effective of UMEC/VIL vs FSC.

Figure 6 Cost-effectiveness acceptability curve of UMEC/VIL vs FSC.

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